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APPLICATION FOR CONSTRUCTION PERMIT <br /> TOa E'IprpYeeR TO BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OF <br /> eve reit I IEATING SYSTEM: JI GAS U ELECTRIC U _ <br /> BUILDING DEPARTMEN-r <br /> 259-8810 <br /> i DEMO{LMON COMBINATION /q BUILD NO _ MECHANICAL PLUMBING SIGN <br /> OWNER / 'DUI+, CITY ZIP PHONE j�1r - <br /> TENANT MAIL ADDRESS CITY ZIP .'HONE <br /> S/1L c_ — a <br /> ARCHITECT OFF DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> 9'_2_-172_y <br /> (IE,NERAL GDNTRAGTDR MAUI ADORESS�CITY ZIP PHONE LICENSE Tit LkmA <br /> S 9.26z 110 T w <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br /> PLUMBING CONTRACTOR MAILADDRECS CITY ZIP PHONE LICENSE) <br /> CLASS OF WORK <br /> ✓NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> CONT CT P TISCH AND PHONE NO <br /> CONTRACTPRICEo K, iib, �,CJ r 'yD ln3 5!� 0—..tCt�J� 3S3 y90 7 <br /> OESCR=WORK,AND 4TI URE FOIITAGE INVOLVED <br /> G :jn& /25` s-s. ." <br /> PROPS€DUs=_OF BUILDING ���,.,d� t�(f�J I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> �— y.� i APPLICA110N AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCR KIN OF PROPERTY(SHOVO BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LOT BLOCK OF - 1„E-� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE <br /> PROVISIONS <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> —� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> /�� �- OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. n <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> PROJECT nonl+t ss ��� 6 (O <br /> /_0l APPLICANTS CITY BUSINESS LICENSE NO ANDBUSINESSNAME <br /> PLUMBING (/ l MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> �^ WATER CLOSEI (TOILET) __ - AIC-AIHNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) _.�Qr UNIT HEATERS-B.T.U. M ; <br /> SHOWER '^ CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP %;^ VENTILATION FAN ; <br /> DISHWASHER 'I- RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER ; <br /> CLOTHES WASHER _ I� WOOD STOVE <br /> _ URINAL METAL FIREPLACE 8 CHIMNEY 07) <br /> DRINKING FOUNTAIN _ FIREPLACE INSERT ; <br /> FLOOR DRAIN ' HEAT PUMP I <br /> BACKFLOW PREVENTERS GAS PIPING _ <br /> ROOF DRAMS—REUNLEADERS I EXHAUST FAN _ <br /> SINK(SERVICE—BAR.ETC.) <br /> S <br /> SUBTOTAL $ SUBTOTAL $ <br /> _ PERMIT S I PERMIT E _ <br /> TOTAL FEE $ TOTALFEE E IT Irl <br /> FOR OFFICE USE ONLY: d@ L rw -3 ' c 7`31AK <br /> FRONT SETBACK REAR SETBACK S.DE SET K EMECHANICAL <br /> FEE RECEIPT NC <br /> 2tl' ?_40 310.;3io..j2 SUSEZONE LOT AREA VACANT SITE VALUATION FEC6 dIK OT CONTS ALLOWABLE TYPE OI CONST.ACTUALki acuwx[r_ �".3 moi'SI'��LDO so t NO OF STORES BASEMENT Oi <br /> OCCUPANCY LOM FIRE SPRNKLERS RM HEIGHT LIMIpTA'ION ADDITIONAL PUN CHECK <br /> N� LQ OTHER <br /> REASON FOR SPRINKLERS <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANSAPPROVEDBV /JD' <br /> CITY OF EVERETT PUBLIC WORKS <br /> .� LOCAL SALES <br /> (�� TAX CODE IS 3105 TOTAL <br />